C-Peptide Has Limited Predictive Value for Need of Insulin Therapy for Glycemic Control: Study Finds

USA: Researchers have found in a new study that C-peptide concentration lacks strong predictive power for determining future insulin therapy needs and achieving glycemic control. This limits its clinical usefulness in inpatient settings.

The findings published online in Diabetes Technology & Therapeutics indicate that C-peptide levels do not strongly predict the future need for insulin therapy or effective glycemic control, raising concerns about its usefulness in inpatient settings.

C-peptide, a byproduct of insulin production, is a key marker of pancreatic beta-cell function and is widely used in outpatient settings to differentiate between type 1 and type 2 diabetes and guide treatment decisions. While it plays a crucial role in diagnosing and managing diabetes, its significance in hospitalized patients with hyperglycemia remains uncertain. Limited clinical data make it unclear whether serum C-peptide concentration has meaningful diagnostic or predictive value in inpatient settings.

Against the above background, Pankaj Shah, Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, Minnesota, USA, and colleagues aimed to evaluate the clinical utility of serum C-peptide concentration in hospitalized patients with hyperglycemia, specifically assessing its predictive value for discontinuation of insulin therapy and achieving glycemic control.

For this purpose, the researchers analyzed data from adults admitted to Mayo Clinic inpatient facilities for acute hyperglycemic emergencies between January 2017 and November 2022. They evaluated the predictive ability of serum C-peptide concentration in determining the likelihood of discontinuing therapeutic insulin, both in the overall cohort and in patients with non-autoimmune non-pancreatitis diabetes (NANP-DM).

Based on the study, the researchers reported the following findings:

  • The study included 187 patients, of whom 63 were women.
  • Patients with type 1 diabetes antibodies had significantly lower serum C-peptide concentrations.
  • An inverse correlation was observed between serum C-peptide concentration and subsequent hemoglobin A1c% [r = (−0.22)].
  • Initial C-peptide levels did not significantly differ between patients who required insulin therapy during follow-up and those who did not.
  • C-peptide demonstrated limited predictive value for achieving glycemic control.
  • Similar findings were observed in the NANP-DM subgroup, where C-peptide showed a limited ability to predict insulin therapy needs and glycemic outcomes.

The study findings indicate that C-peptide concentration lacks strong predictive value for determining future insulin therapy needs or achieving glycemic control, limiting its clinical utility in inpatient settings.

The researchers emphasized the need for evidence-based approaches in diabetes management, stressing that diagnostic tests should offer meaningful clinical insights. They suggested that, for now, healthcare providers may need to prioritize traditional indicators—such as blood glucose levels, insulin requirements, and overall patient condition—over C-peptide levels to optimize inpatient diabetes care.

Reference:

Costa DN, Kudva YC, Jensen MD, Shah P. Clinical Utility of Serum C-Peptide Concentration for Hospitalized Patients with Hyperglycemia. Diabetes Technol Ther. 2025 Feb;27(2):121-127. doi: 10.1089/dia.2024.0246. Epub 2024 Sep 20. PMID: 39226586.

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Multiple arterial grafting improves long-term survival over single arterial grafting: JAMA

A new study published in the Journal of American Medical Association showed that regardless of left ventricular failure, surgeons should emphasize multiple arterial grafting over single arterial grafting to increase long-term survival. Complete arterial revascularization, which removes saphenous vein grafts, is linked to the highest benefit.

When compared to single arterial grafting with additional saphenous vein grafts, multiarterial cardiac bypass surgeries have better clinical results. It is unclear, therefore, if multiarterial grafting offers a survival benefit for patients with different degrees of left ventricular dysfunction. Thus, to examine the long-term survival results of patients following multiple vs. single arterial grafts, stratified by preoperative ejection fraction, Justin Ren and team carried out this investigation.

Data from a multicenter population-based cardiac registry set up by the Australian & New Zealand Society of Cardiac & Thoracic Surgeons and linked to the National Death Index were used in complete-case retrospective cohort research. Those who had primary isolated coronary bypass surgery between June 1, 2001, and January 31, 2020, were considered participants.

Nonadults, reoperations, concurrent or prior heart surgery, single-graft surgeries, and instances lacking arterial grafts were also excluded. The patients were stratified by their preoperative left ventricular ejection fraction who received either single or multiple arterial grafts were included in the primary exposure. The main endpoint of the study was long-term all-cause mortality.

A total of 59,641 patients were included in the research (mean [SD] age at surgery: 65.8 [10.2] years; 48,321 men [81.0%]). 5.0 years was the median follow-up period (IQR: 2.3–8.6 years). Among patients with a normal left ventricular ejection fraction, multiarterial grafting was linked to a 19.0% relative decrease in all-cause mortality as compared to single artery transplantation.

The patients with mild, moderate, and severe left ventricular dysfunction showed comparable survival advantages. The multiarterial survival benefit by ejection fraction stratification did not differ significantly, according to a multivariable Cox proportional hazards regression interaction-term analysis. With the exception of cases where the left ventricular ejection fraction was less than 30%, multiarterial grafting using just arterial conduits was linked to greater survival advantages when compared to other multiarterial operations using saphenous vein grafts.

Overall, irrespective of the level of preoperative left ventricular ejection fraction (LVEF), multiple arterial grafting (MAG) in coronary artery bypass grafting (CABG) significantly decreased the risk of long-term all-cause mortality when compared with SAG, according to this retrospective cohort study that used a binational cardiac surgery database. When TAR was attained, the longevity benefit was highest, especially for patients with intact LVEF.

Source:

Ren, J., Bloom, J. E., Chan, W., Reid, C. M., Smith, J. A., Taylor, A., Kaye, D., Royse, C., Tian, D. H., Bowyer, A., El-Ansary, D., & Royse, A. (2025). Survival outcomes after multiple vs single arterial grafting among patients with reduced ejection fraction. JAMA Network Open, 8(4), e254508. https://doi.org/10.1001/jamanetworkopen.2025.4508

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FDA Approves Atzumi Nasal Powder for Acute Migraine Treatment

The US Food and Drug Administration (FDA) has approved Atzumi, a 5.2 mg dihydroergotamine (DHE) nasal powder, for the acute treatment of migraine with or without aura in adults. Developed by Satsuma Pharmaceuticals, Atzumi is the first and only DHE nasal powder and uses the SMART platform for simplified drug delivery.

Migraine is a neurological disorder that is thought to be the result of temporary changes in the chemicals, nerves and blood vessels in the brain, with symptoms that are often incapacitating. According to the American Migraine Foundation, approximately 40 million Americans live with migraine. It is the second leading cause of disability worldwide in terms of time lost to disability and most common cause of disability among young women.

“The approval of Atzumi is a milestone to celebrate, providing a new option for the acute treatment of migraine combining long-proven benefits of DHE with a patient-friendly and easy-to-use delivery system developed based on SNBL’s novel intranasal drug delivery platform technology,” said Dr. Ryoichi Nagata, President and CEO of Satsuma. “We believe that Atzumi will contribute to improving the quality of life of patients struggling for relief from these highly disabling problems.”

“DHE plays a unique clinical role in the acute treatment of migraine, providing patients long lasting effects and the unique ability to provide benefit even when taken late in a migraine attack. The convenience of Atzumi, the only DHE nasal powder, will offer patients ease of use combined with the important known DHE clinical advantages”, said Dr. Stewart J. Tepper, M.D., Vice President of the New England Institute for Neurology and Headache in Stamford, Connecticut.

About Atzumi

Atzumi is a proprietary drug device product incorporating both Satsuma’s advanced nasal powder formulation of dihydroergotamine (DHE) administered via its unique nasal delivery device. The product is designed to provide patients an easy-to-use and easy-to-carry treatment option.

The FDA approval for Atzumi is based on two clinical studies (Phase 1 PK trial and ASCEND Phase 3 open-label, long-term safety trial), which demonstrated fast absorption, rapid achievement of high DHE plasma concentrations, and sustained DHE plasma levels over time as well as safety and tolerability in subjects with migraine.

About Dihydroergotamine (DHE)

Since its approval in 1946, DHE has long been recommended in published migraine treatment guidelines as a first-line acute treatment option for migraine and has significant advantages versus other anti-migraine treatments for many patients. However, disadvantages of current DHE liquid nasal spray and injectable products, including invasive and burdensome administration and/or sub-optimal clinical performance, have limited the widespread use of DHE.

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GLP-1 Drugs May Increase Rejection Risk in Lung Transplant Recipients, Study Suggests

A recent study presented at the 2025 International Society for Heart and Lung Transplantation (ISHLT) annual meeting suggests that glucagon-like peptide-1 receptor agonists (GLP-1 RAs)—a class of drugs widely used to treat type 2 diabetes and obesity-may elevate the risk of organ rejection in lung transplant recipients.

Researchers, led by Dr. Zainab Dhanani and colleagues, investigated the outcomes of lung transplant patients who had been prescribed GLP-1 RAs such as semaglutide or liraglutide. The analysis compared these patients to matched controls who were not taking GLP-1 agents.
Findings indicated a statistically significant increase in episodes of acute rejection and possibly chronic lung allograft dysfunction (CLAD) in those receiving GLP-1 RAs. GLP-1 RAs have been celebrated for their cardiometabolic benefits and their role in weight reduction, especially in transplant populations where obesity is a risk factor. However, their influence on immune modulation may unintentionally provoke immune responses against transplanted lungs. The underlying mechanism remains unclear but may involve increased immune activation or altered pharmacokinetics of immunosuppressants.
The researchers caution against immediate changes in clinical practice, emphasizing the need for further large-scale studies to validate these findings. However, they recommend careful monitoring of lung transplant patients who are prescribed GLP-1 agents and a multidisciplinary approach when considering their use in this population. As GLP-1 RAs gain popularity for metabolic disease management, this study highlights the importance of evaluating potential immunological consequences in vulnerable populations, such as transplant recipients.

Reference:

International Society for Heart and Lung Transplantation. Source Reference: Dhanani Z, et al “The impact of glucagon-like peptide-1 receptor agonists on lung transplant outcomes” ISHLT 2025.

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SGLT2 inhibitors significantly reduced Cholesterol Levels in CKD Patients: Study

A new study published in the Metabolites journal found that SGLT2 inhibitors (SGLT2i) significantly reduced total cholesterol levels in all chronic kidney disease (CKD) patients over a 24-month period, irrespective of their diabetes mellitus (DM) status. However, no notable changes were observed in triglycerides (Tg), LDL cholesterol (LDLc), or HDL cholesterol (HDLc) levels.

The study analyzed the medical records of 75 patients diagnosed with CKD who had been on SGLT2i therapy. Key biochemical markers, kidney function indicators, and blood pressure readings were compared between baseline values and those taken two years into the treatment.

The study found a statistically significant reduction in total cholesterol (Chol) levels across all participants, regardless of whether they had diabetes mellitus. While triglycerides (Tg) and low-density lipoprotein cholesterol (LDLc) also trended downward, these changes were not statistically significant. High-density lipoprotein cholesterol (HDLc) levels showed a slight increase, though again, this was not significant enough to draw strong conclusions.

Despite expectations, creatinine clearance (Ccr), a marker of kidney filtration ability, showed a significant decrease over the 24-month period, suggesting some progression of kidney function impairment. Serum urea (Sur), another marker of declining renal performance, significantly increased. However, levels of proteinuria (Prt), a key indicator of kidney damage, remained stable, suggesting that SGLT2i may have a protective effect on kidney structure even as filtration metrics fluctuate.

Blood pressure outcomes revealed a significant reduction in diastolic blood pressure (DBP), which could contribute to cardiovascular risk reduction in this patient population. This adds to the growing body of evidence supporting the cardiovascular benefits of SGLT2 inhibitors.

The study concluded that SGLT2 inhibitors appear to contribute to better cholesterol control and some cardiovascular benefits in CKD patients, with a complex but manageable impact on renal function. These findings reinforce the role of SGLT2i in holistic CKD management and may prompt further prospective studies to explore their long-term outcomes and mechanisms of action.

Overall, this study highlights the growing interest in SGLT2i therapies not just for their glucose-lowering abilities in diabetic patients, but also for their broader implications in CKD management, particularly in improving lipid profiles and offering mild blood pressure benefits.

Source:

Gajić, S., Janković, S., Stojadinović, M., Filić, K., Bontić, A., Pavlović, J., Mrđa, I., Petrović, K., Hadži-Tanović, L., Žunić, J., Kostić, M., Kezić, A., & Baralić, M. (2025). The effects of SGLT2 inhibitors on lipid profile and kidney function in patients with chronic kidney disease regardless of diabetes and hypertension status. Metabolites, 15(4). https://doi.org/10.3390/metabo15040271

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Cryotherapy Effectively Reduces Postoperative Pain After Root Canal Treatment, suggests study

Researchers have found in a new study that Cryotherapy may significantly reduce postoperative pain in single-visit root canal treatments of molars with pulp necrosis and symptomatic apical periodontitis (SAP). This offers a biocompatible, cost-effective, and simple pain management option.

The present study aimed to assess the effects of intracanal cryotherapy on pain following single-visit non-surgical root canal treatment (NSRCT) of molar teeth with pulpal necrosis and symptomatic apical periodontitis (SAP).

This parallel-two arm, single-blind, randomized superiority clinical trial was registered at www.clincaltrials.gov (NCT05611736). Patients referred for NSRCT meeting the inclusion criteria were included. Preoperative radiographs, pulp sensibility tests, and pain scores on the visual analog scale (VAS) were recorded. Following shaping and cleaning, 302 patients were randomly allocated to the two groups (n = 151). In the experimental group, final irrigation was done using 0.9% physiologic saline solution at 2.5 °C, whereas in the control group, final irrigation was done using the same solution at room temperature.

All treatments were performed in a single visit. Analgesics intake and presence, duration, and intensity of pain using the VAS at 6, 24, 72 h, and 1 week were recorded. Any adverse events were recorded. Data was analyzed using the Mann–Whitney U test and the Student’s t test (P < 5%). Results: Patients in the cryotherapy group had significantly less postoperative pain at 6, 24, and 72 h (P < 0.05). There was no difference in postoperative pain at 1 week (P > 0.05). No adverse event was recorded in either group during or immediately after root canal treatment. Cryotherapy significantly reduces postoperative pain in single-visit root canal treatment of molars with pulp necrosis and SAP.

It can be considered a biocompatible, economical, and straightforward method for managing postoperative pain.

Reference:

Ahmad MZ. Effects of intracanal cryotherapy on postoperative pain in necrotic teeth with symptomatic apical periodontitis: a randomized controlled clinical trial. Front Dent Med. 2025;6. doi:10.3389/fdmed.2025.1543383.

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Pre-Pregnancy BMI and Weight Gain Linked to Higher Cesarean Delivery Risk, suggests study

Recent study focused on investigating the impact of pre-pregnancy BMI and changes in gestational weight gain (GWG) trajectories on cesarean section rates in women with gestational diabetes mellitus (GDM). The research was conducted in Taiwan with 947 participants diagnosed with GDM. The study classified GWG patterns into non-rapid excessive weight gain and rapid excessive weight gain groups, with the latter contributing significantly to cesarean section rates. Pre-pregnancy BMI played a crucial role, with normal and overweight/obese women having higher odds of cesarean sections. Multiparous women and those with rapid excessive weight gain trajectories were more likely to undergo cesarean delivery.

Importance of Educating Women on Weight Management

The findings emphasized the importance of educating women on weight management from pre-pregnancy through pregnancy to reduce cesarean section incidences. Specifically, women with GDM showing rapid excessive weight gain should receive particular attention to minimize the cesarean delivery risk. Gestational weight gain in the first trimester is associated with maternal fat, while weight gain in the second and third trimesters affects fetal growth. It was highlighted that excessive GWG poses a threat to birth outcomes, and that maintaining appropriate weight gain is crucial for avoiding adverse childbirth outcomes.

GWG Trajectories and Relationship with Cesarean Incidences

The study utilized group-based trajectory modeling to identify different GWG trajectories and their relationship with cesarean section incidences. The results indicated that excessive and rapid GWG was a high-risk factor for cesarean section, especially in underweight women before pregnancy. Additionally, the study discussed the physiological mechanisms linking excessive GWG, hyperglycemia, fetal hyperinsulinemia, and adverse birth outcomes. Recommendations included emphasizing pre-pregnancy weight management and gestational weight changes to reduce cesarean section rates in women with GDM.

Addressing Pre-pregnancy BMI and Monitoring GWG Trajectories

Overall, the study highlighted the importance of addressing pre-pregnancy BMI, monitoring GWG trajectories, and providing targeted interventions to prevent rapid and excessive weight gain during pregnancy, particularly in women with GDM. The findings contribute to understanding the relationship between GWG patterns and cesarean sections, emphasizing the need for tailored interventions to improve maternal and infant health outcomes.

Key Points

– The study aimed to assess the influence of pre-pregnancy BMI and variations in gestational weight gain (GWG) patterns on cesarean section rates in women diagnosed with gestational diabetes mellitus (GDM) in Taiwan, involving 947 participants.

– Two GWG trajectory groups were identified: non-rapid excessive weight gain and rapid excessive weight gain, with the latter demonstrating a significant association with increased cesarean section rates.

– Women with normal and overweight/obese pre-pregnancy BMIs were found to have higher chances of undergoing cesarean deliveries, especially if they were multiparous and had rapid excessive weight gain trajectories during pregnancy.

– Educating women on weight management is crucial throughout pre-pregnancy and pregnancy to mitigate the risk of cesarean sections, particularly for those with GDM exhibiting rapid excessive weight gain to reduce adverse birth outcomes.

– Excessive and rapid GWG, particularly in underweight women before pregnancy, was identified as a major risk factor for cesarean deliveries, with physiological mechanisms connecting excessive GWG, hyperglycemia, fetal hyperinsulinemia, and negative birth outcomes.

– The study emphasizes the significance of addressing pre-pregnancy BMI, tracking GWG trajectories, and offering tailored interventions to prevent excessive weight gain during pregnancy, with a specific focus on women with GDM to enhance maternal and infant health outcomes.

Reference –

Tzu-Ling Chen et al. (2025). Gestational Weight Gain Patterns As Predictors Of Cesarean Deliveries In Women Diagnosed With Gestational Diabetes Mellitus. *BMC Pregnancy And Childbirth*, 25. https://doi.org/10.1186/s12884-025-07222-x.

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Hyperbaric oxygen Safe with Limited Efficacy in Reducing severity of radiation-induced dermatitis: Study

Researchers have found in a pilot study that hyperbaric oxygen therapy (HBOT) did not significantly reduce the severity of radiation-induced dermatitis (RID). However, it was safe, well tolerated, and showed potential benefits in enhancing patient comfort and quality of life. Further large-scale trials with optimised protocols are necessary to determine its effectiveness in RID management.

Radiation-induced dermatitis (RID) is a common adverse effect of adjuvant radiotherapy in patients with breast cancer, often leading to discomfort and reduced quality of life. Hyperbaric oxygen therapy (HBOT) has been proposed as a potential intervention to mitigate RID, but its efficacy remains uncertain. This pilot study aimed to assess the feasibility, safety, and preliminary efficacy of HBOT in reducing RID severity. This single-institution, randomized, controlled pilot study included 30 patients undergoing adjuvant radiotherapy for breast cancer. Participants were assigned to either HBOT (100% oxygen at 1.5 atmospheres absolute, 30 min per session, three times per week, for 7 weeks) or standard care. The primary outcome was to determine whether HBOT reduces the incidence of grade 2 or higher RID, based on Radiation Therapy Oncology Group criteria. Secondary outcomes included the Skindex-29, Catterall Skin Scoring Profile, Numeric Rating Scale (NRS), and EORTC QLQ Core Questionnaire-C30 scores. Results: Twenty-five patients completed the study. The incidence of grade 2 or higher RID was 73.3% in both the HBOT and control groups, with no significant difference (p = 0.700). No statistically significant differences were observed in primary or secondary endpoints. Trends toward lower skin-related discomfort and improved patient-reported outcomes in the HBOT group were noted but did not reach statistical significance. HBOT was well tolerated, with no serious adverse events reported.This pilot study did not demonstrate a significant reduction in RID severity with HBOT. However, the therapy was safe and well tolerated, with potential benefits in patient comfort and quality of life. Larger trials with optimized HBOT protocols are needed to clarify its role in RID management. Trial Registration Number and the date of registration: NCT06158347 (28/11/2023) and KCT0009847 (15/10/2024).

Reference:

Lee JY, Hyun MH, Yang G, Lee S. Efficacy and safety of hyperbaric oxygen therapy for radiation-induced dermatitis in patients with breast cancer: a randomized pilot study. Support Care Cancer. 2025 Apr 21;33(5):399. doi: 10.1007/s00520-025-09463-0. PMID: 40259026.

Keywords:

Hyperbaric, oxygen, Safe, Limited, Efficacy, Reducing, severity, radiation-induced, dermatitis, study, Lee JY, Hyun MH, Yang G, Lee S, Breast cancer; Hyperbaric oxygen therapy; Radiation-induced dermatitis; Skin toxicity.

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Increased Residential Greenness improves Maternal Vitamin D Deficiency in Areas with air pollution: Study

A recent study published in Environmental Pollution investigated the relationship between residential greenness and maternal vitamin D deficiency (VDD) during pregnancy. The findings indicate that higher levels of surrounding greenness are associated with a reduced risk of Vitamin D Deficiency in expectant mothers. This inverse relationship is particularly significant in areas with elevated concentrations of fine particulate matter (PM₂.₅). The study also suggests that the beneficial impact of greenness on vitamin D status may be partially mediated by a reduction in PM₂.₅ exposure.

Adequate vitamin D is essential for the health of both the mother and foetus, and it can be influenced by environmental factors. However, research on the associations between greenness exposure and vitamin D concentrations during pregnancy is limited. This retrospective birth cohort study, conducted from 2014 to 2018, assessed the greenness of residences using the satellite-derived normalised difference vegetation index (NDVI). Serum 25-hydroxyvitamin D [25(OH)D] concentrations were categorised as non-deficient (≥50 nmol/L) or deficient (<50 nmol/L). Multiple log-binomial regression models were used to estimate the association of NDVI with serum 25(OH)D concentrations and vitamin D deficiency (VDD). Subgroup and mediation analyses were conducted to estimate the association of ambient particulate matter (PM) on the association between NDVI and VDD. A total of 64,663 pregnant women with a mean maternal age of 30.6 (standard deviation: 3.86) years were included. 250-m NDVI was negatively associated with the risk of VDD (per 0.1-unit increase, relative risk [RR]: 0.98, 95% CI: 0.97–0.99). With the highest quartile of NDVI exposure as the reference group, the upper-middle quartile (RR: 1.02, 95% CI: 1.00–1.03), and lowest quartile (RR: 1.03, 95% CI: 1.01–1.06) had an increased risk of VDD. At higher PM2.5 exposure concentrations, 250-m NDVI exposure was negatively associated with the risk of VDD (RR: 0.98, 95%CI: 0.97–0.99, per 0.1-unit increase), but not at lower PM2.5 exposure concentrations. Among pregnant women with higher PM2.5, the mediation of PM2.5 exposure on the association between 250-m NDVI and VDD was 44.70% (P = 0.0116). Among pregnant women with higher PM10 exposure, the mediation of PM10 exposure on the association between 250-m NDVI and VDD was 17.98% (P = 0.002). These findings suggest that higher residential greenery significantly reduces the risk of VDD in pregnant women, particularly in those exposed to increased PM concentrations.

Reference:

Dongjian Yang, Yanling Shen, Qun Wang, Xin Sun, Mengxiang Li, Jinjing Shi, Lei Chen, Jun Zhang, Xinhua Ji. Association of greenness exposure with serum vitamin D status and effects of ambient particulate matter among pregnant women in early pregnancy,

Environmental Pollution, 2025, 126067, ISSN 0269-7491, https://doi.org/10.1016/j.envpol.2025.126067.

(https://www.sciencedirect.com/science/article/pii/S0269749125004403)

Keywords:

Dongjian Yang, Yanling Shen, Qun Wang, Xin Sun, Mengxiang Li, Jinjing Shi, Lei Chen, Jun Zhang, Xinhua Ji. Association, greenness, exposure, serum, vitamin D, status, effects, ambient, particulate, matter, among, pregnant, women, early, pregnancy

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How to Enhance Paediatric Anaesthesia Training, Bridge Skill Gap through Targeted Curriculum and Supervision?

Recent study investigates the training gaps in pediatric anesthesia education among postgraduate trainees and educators. Given the specialized nature of pediatric anesthesia, effective management is crucial yet often not met by current training programs. A cross-sectional survey was conducted with a sample of 567 individuals, comprising anesthesia trainees, consultants, and educators, receiving a 25.3% response rate from 144 participants. The aim was to assess exposure to pediatric anesthesia, teaching methodologies, and perceived competency in performing essential clinical tasks. The methodology relied on a self-administered Google questionnaire, validated by experts in the field, which included 29 questions focusing on various aspects of pediatric anesthesia education. The survey sought to gather insights on clinical exposure, supervising methodologies, and assessment strategies. The results revealed that the median score for exposure to pediatric anesthesia was rated as ‘good’ on a scale of 1 to 5 but highlighted a concerning reliance on direct proactive supervision, as 47% of trainees primarily assisted rather than independently performed procedures.

Trainee Exposure

Among the responding trainees, only 19% reported exposure to children under one year, with elective placements in pediatric operating theaters noted by 25% of participants in the first six months of training, increasing to 36.81% by the second year. However, the overall performance of critical functions such as intravenous line insertion, mask ventilation, laryngeal mask airway insertion, tracheal intubation, and caudal block was evaluated as moderate, indicating insufficient opportunities for hands-on practice.

Skill Correlation

Notably, a significant positive correlation (r = 0.714) was identified between mask ventilation and tracheal intubation skills, suggesting that increased practice in mask ventilation may enhance capabilities in intubation – an essential competency in pediatric anesthesia. Teaching methods were primarily traditional, emphasizing interactive lectures for knowledge acquisition, while hands-on practice and mentoring were recognized for skill development and attitude formation. Concerns were raised regarding the limited formative assessments implemented in the training programs, with only 36% of respondents indicating their use, primarily through Objective Structured Clinical Examination (OSCE). Reflective practice was encouraged among 76% of students, yet only 69.9% maintained personal logbooks, demonstrating low engagement with formative assessments essential for professional growth.

Study Limitations

Various limitations of the study were identified, particularly the geographical imbalance in participant responses and a skewed representation between students and educators. This highlights the necessity for a standardized national approach to pediatric anesthesia training that ensures adequate exposure and skill competencies across institutions, particularly those facing resource limitations. In conclusion, the findings suggest that a shift to a competency-based medical education framework is paramount, integrating formative assessments and experiential learning opportunities to bolster proficiency in pediatric anesthesia. There is a clear need for curriculum enhancement that focuses on skill development and fostering independent practice, which could be achieved through a well-structured framework involving competency committees and systematic evaluations of trainee performance. The emphasis on establishing clear entrustment goals and implementing simulation-based learning could substantially bridge the gaps identified in the training process, ultimately improving patient safety and care in pediatric anesthesia.

Key Points

-Training Gaps Identified:- The study highlights significant gaps in pediatric anesthesia education for postgraduate trainees, emphasizing that current training programs often fail to provide adequate management techniques necessary for this specialized field.

– -Trainee Experience and Exposure Levels:- Only 19% of surveyed trainees had experience with pediatric patients under one year old, and while elective exposure increased from 25% in the first six months to 36.81% in the second year, hands-on practice for critical procedures like intravenous line insertion and tracheal intubation was deemed insufficient.

– -Correlation between Skills:- A strong positive relationship (r = 0.714) between mask ventilation and tracheal intubation skills was found, indicating that improving skills in mask ventilation could enhance intubation performance, which is crucial in pediatric anesthesia settings.

– -Teaching Methodologies and Assessment Practices:- Traditional teaching methods dominated, focusing on interactive lectures for knowledge acquisition rather than on hands-on practice. Furthermore, formative assessments were underutilized, with only 36% of respondents reporting their implementation, primarily via Objective Structured Clinical Examination (OSCE).

– -Engagement with Reflective Practice:- While a majority (76%) of trainees were encouraged to engage in reflective practices, only 69.9% maintained personal logbooks. This low level of engagement highlights the need for better integration of formative assessments which are vital for professional development.

– -Recommendations for Curriculum Improvement:- The findings advocate for a shift toward a competency-based medical education framework, incorporating formative assessments, experiential learning, and simulation-based training to enhance skills and encourage independent practice, ultimately aimed at improving patient safety and care outcomes in pediatric anesthesia.

Reference –

Vasudha Devi et al. (2025). Perceived Learning Gaps In Paediatric Anaesthesia Training: A Cross -Sectional Survey. *Indian Journal Of Anaesthesia*. https://doi.org/10.4103/ija.ija_807_24.

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